POPTS Battle Continues: AB 783 Rescheduled for Hearing June 27

The ongoing legislative battle in California over physician owned physical therapy services (POPTS) will face a critical juncture on June 27. California Assembly Bill 783 has been posted for reconsideration in the Senate Standing Committee on Business, Professions, and Economic Development. If the legislation does not pass out of committee on Monday, it will not be able to be considered again until 2012.

AB 783 would specifically add licensed PTs to the list of "healing arts practitioners" who may be employees of medical, chiropractic, and podiatric corporations.

Comments

I would love to hear why the APTA has any stance on who owns a facility that provides Physical Therarpy. I sure dont want to be owned by Washington D.C.! which give it time, we will. I think we have bigger issue's to fry at this time.

Posted by Blake Laing SPTA
on 6/24/2011 11:08 PM

Blake, because we do not yet have direct access in CA, PTs rely on physician referrals for patients. If physicians begin hiring PTs, it has been shown (refer to the NBC link) that they will over-prescribe physical therapy to their own facility to make more money. In addition to this, the quality of the physical therapist becomes questionable if he/she treats a patient who is not a candidate for physical therapy. It puts the PT in an ethical dilemma in more than one sense. Autonomous practices that have a long standing track record of excellence will be ignored by doctors because they will only refer in-house, regardless of the in-house service quality. That in itself is worrisome.

Posted by Brent
on 6/25/2011 11:44 AM

It is time for the client to chose their own Physical Therapist.
Physicians need to stop cannalicing money in their own pocket.

Posted by Roel Fung-A-Wing
on 6/25/2011 11:49 AM

I've been in clinical PT for 49yrs and have worked in every
type of facility - acute, chronic rehab, home care, POPTS (for 25
yrs), and finished working full time in my own practice for 12yrs.
For the past 4yrs, I work part-time doing prn coverage - some of
which is in a POPTS facility and some in private PT-owned offices.
After approx 5 decades in clinical settings, I've "seen it all." There
are as many instances of inappropriate over-utilization of PT
services in PT-owned facilities as in POPTS facilities. The 2 POPTS facilities I've been associated with consistently told
patients they had the right to use any PT office or facility they
chose and were not strongly urged to use the POPTS facilities.
I personally made that policy because as the chief PT, I was
given the authority to design all administrative policies for
the PT dept. My relationship with the physicians, as well as the
staff PTs I hired, was always that of a professional colleague
treating our patients as part of the team approach in rehab. I can
understand the antipathy of the PT profession towards the POPTS concept. I realize the 2020 goals mandate the eradication of POPTS as an important cornerstone of the doctorate trend.
However, not every situation can be "painted with same broad brush"- I know this is a common rejoinder by PT POPTS employees. Listen to an old relic in PT - be careful what you wish for.

Posted by PT relic from the 60s
on 6/25/2011 11:03 PM

Relic from the 60s. I like you! I don’t have the experience in PT but I do have many years in management. I have not seen a convincing argument of why one type of person can or cannot own a facility. Where money goes? Too much PT prescription? It sounds like people are jealous. If I went to school to become a DR. guess what, I have bills and I have money. I want to increase my earnings just like everybody else in this world. None of those issues are caused by a reason of being a DR., a PT of the street can do the same. I will listen to a relic!

Posted by Blake Laing -> AHW_?L
on 6/26/2011 9:53 AM

In response to 6/25/2011 suggestion. There are few
POPTS they give choices to patient .There may be written instruction in his POPTS but there is direct and indirect instruction for staff to direct patient to their own clinic. To see this pressure he has to look out of the box vision. More over mr relic salary check is signed by doctor owner of that POPTS. He has to talk for his bread. Doctors feels Physical therapy profession is cash cow for them. They are spoiling this profession. In my family I am the therapist and others are doctors . I know inside story of POPTS.
POPTS should close. Physical therapy is independent profession . It should be own and run by therapist. Unless you have this mental set up
you will never grow this profession.This is what happened for last 50 years. So goodby to POPTS .

Posted by Deepak
on 6/27/2011 8:56 AM

To the PT relic, I would assert that you are not looking closely enough at situations. Although I respect your years of experience, my own experience as a former practice owner and the many meetings I have had over the years with other private practice owners in Illinois would suggest that your perspective is a naive one. The reality is that I never got a referral from any POPTS clinic in 6 years of practice. Most Chicagoland PT private practice owners were not receiving any referrals from orthopedic surgeons by 2007. They were referring all in-house. It's all about money and a also encompasses a lack of respect piece towards physical therapists. For the most part, we are not seen as professionals, colleagues or as having a respected diagnostic opinion in orthopedic care in the eyes of orthopedic surgeons. We are seen as an ancillary service which throws generic treatments at patients and can generate revenue. That is the truth. One more thing. A physical therapist who works in a POPTS does not have the power to voice opposition to his "boss" the physician like he/she would in a private practice because... they are their boss. Think about it, we have to adjust our tone, words, approach to our boss because they control our job and paycheck. Unfortunately, for example, that means that if you the PT are highly confident that a patient's condition can be completely helped by your care, but the surgeon recommends surgery, then you can only say so much because it's your boss. As a result, best care is compromised, you feel frustrated and unnecessary health care dollars are spent all because you couldn't speak up. That's the problem.

Posted by Peter Zepelak
on 6/27/2011 2:12 PM

I am a physical therapist assistant who works in a POPTS, however I am employed by a private company who is contracted with the surgeons to provide physical therapy services in their clinic.
Prior to this job, I worked in a hospital based outpatient physical therapy center, so I am able to compare firsthand some of the differences between the two. While I respect all of the above voiced opinions regarding this issue, I feel one facet of working in a POPTS has not been discussed. Ease of communication with the referring physician is vastly superior to working in a department where the physicians are not present. This frequent and easy to achieve communication, I feel, greatly enhances the physician/PT (PTA) relationship, improves quality of the rehab performed, AND patients love to see their clinician talking with their doctor regarding their care. Patients have told me this time and again, and they observing this communication leads to greater patient belief in the clinician and what they are asking them to do, ultimately assiting with obtaining a better outcome. As an aside, our Doc's tell the patients they have the right to recieve therapy anywhere, but may feel more comfortable because they know the therapists who will be providing the care and trust in the outcomes of the rehab. So, even though the Doc's are making money from the rehab, they also have faith that the therapists won't do anything to jeoporadize the surgical outcome. This type of relationship with the therapist's and Doc's is very tough to establish in a freestanding clinic.

Posted by Trevor
on 6/27/2011 7:01 PM

I have been a PT for 32 years, and have practiced in acute care, in a private practice under another PT, and in a couple of different POPTS settings, before opening my own practice 23 years ago. The most difficult environments for me, from the perspective of providing quality care occurred in the POPTS settings. I understand that there can be some quality care provided in a POPTS, but the basic structure is improper. I can also tell you that when Stark I was in place, my clinic did very well. When Stark II changed the ownership, clinics sprang up all around us...every orthopedic surgeon, neurosurgeon, pain management doc, and most PM&R own their own. We get the patients that have been through these facilities and didn't get well. The majority of them report that they "did exercises, mostly on their own, which they could have done at a gym or at home". They all report that no one evaluated them nearly as thoroughly, or did the types of manual therapy that they receive at our clinic. And if that doesn't raise your level of concern, a patient shared her EOB's with me, and the insurance company paid the POPTS 2-1/2 times MORE for the same 3 CPT codes...evidence of less care, and the negative impact on the cost of health care...there is plenty of evidence out there, if anyone has the honesty and integrity to look!

Posted by Patti L. Schwartz, PT
on 6/27/2011 7:53 PM

Many fine arguments on both sides. The one I don't hear is the fact that the physician(remember this is MD, DO, AND Chiropractor) determines who needs therapy, for how long, and whose pocket it fills. The private practitioner does have to please the referral practitioner in order to get more referrals, like the POPTS practitioner has to please the referring physician who signs the paycheck. The difference is the private practitioner pleases by quality work, the POPTS practitioner pleases by quanity work.

Posted by Don J Hunter, PT, DPT,MTC
on 6/27/2011 8:00 PM

I respect the comments from those addressed to the 60s relic.
I'm certainly not as naive as some may think. As for as my
individual situation is concerned, I spent 25yrs of my career
in one of the most respected ortho practices in a large east
coast city, home of 2 prestigious medical schools where most
of the docs in the practice trained. Both of these institutions
have progressive PM&R depts where residents of all specialities
rotated through and were trained in the team approach to
rehab - where PTs were given the respect , attention and
valued for their skills and opinions. The point is that myself and other PT staff members worked for surgeons who consulted us
as well as we consulted them frequently in the post-surgical
cases we treated. I maintained a list of 26 private PT practices
in the metropolitan that we consistently referred patients as needed -by patient's requests and/or by our initiative based
upon travel convenience etc. When we suggested a patient
had reached maximum benefit, more often than not, the
patient was discharged. I know that not all POPTS practices
over the past 30 - 40 yrs the trend has grown, are ethical,
quality- oriented, or even honest. However, one would
think that a professional PT would be able to evaluate a bad
situation and leave. I also know that some PTs knowingly involve
themselves in unethical and illegal employment situations for
the renumeration. Just look up your individual state's PT board
disciplinary actions and be amazed,disgusted, dismayed by the action of some PTs. Just as some few PTs are rotten apples, some
practices - POPTS and PT-owned practices are rotten. I do not
find fault with profession's stance on the issue;however, I do find
a lot of fault with the holier-than-thou attitude of many in our
profession towards those of us who work or did work in POPTS
situations. I can assure those who have commented about my
postings that my reputation and those of some of my experienced co-workers has been outstanding amongst the
largest orthopedic and rehab practices in our community, as well
the regard of the many patients we have worked with over the yrs. Many of the large corporate practices that employed and still employ thousands of PTs around the country have horrible
reputations for poor quality of care, over-utilization of therapy
services, factory-type scheduling, etc,etc. I also know of many
instances of PTs leaving these corporate mills after working
in these offices. The point is that in many non-POPTS practices that are
supposedly are more professional than POPTS are engaged in
egregious behaviors that would make a con-man jealous.
Where is the APTA on the issues in these corporate So-called
rehab that many of us have complained about for the last 15+ years? Why has no "official" position been publicized on this
on-going problem?

Posted by relic from the 60s
on 6/27/2011 10:59 PM

First of all, I would like to apologize to "PT relic from the 60's." It was unfair and disrespectful for me to characterize you as naive. That being said, I hear your points and agree that there certainly is "corruption" on both the PT side and the POPTS side of the issue. However, the data supports that the abuse of services are happening to a much larger degree on the POPTS side of things (both in number of visits, reimbursement per unit, total health care dollars). Also, it is fair to ask if the APTA is doing anything to address proper billing and issues with regards to PT private practices but I think that the bigger issue here is the current affect of POPTS on our profession. Also, by no means do I believe that our problems will go away if and when POPTS goes away but I do think it will be a step in the right direction. It will hopefully be one more step towards autonomy and establishing ourselves as a respected profession in the medical community. I don't think we're there yet.

Posted by Peter Zepelak
on 6/28/2011 1:07 PM

To Peter Zepelak
No need to apologize. I certainly agree the goal of independent
practice for our profession cannot be achieved without
the decrease in POPTS practices, if not the outright elimination
of them. But, as a PT moving closer to complete retirement
( hopefully not in the near future ), I feel some anxiety - at times-
as the profession moves in a direction that will place us in direct
competition with physicians. As strange as that is to contemplate, that will be just one of the effects as we separate
ourselves from the cooperative/team approach. I don't
suggest that independent practice is an unworthy goal for us:
however, the devil is in the details, of course. What will be the
effects of direct access upon those who do not want to be in
private practice, in hospitals, ECFs, home care and other entities
wedded to insurance co. who insist on MD referrals- even in
states with direct access now. I am glad, as the 60s relic, that
these problems will be up to you young turks to wrestle with.

Posted by PT relic
on 6/28/2011 7:34 PM

When the insurance reimbursement becomes so miniscule that it is no longer feasible for the physician to have a therapy office, they will close. That will leave the DPTs of 2020 to have the therapy offices all to themselves. May sound cynical, but it is a business. When the physician can no longer make a profit, they will turn the business over to the DPTs. As an observation when I retired from acute care in 2010 I was making the same hourly salary as I was earning in 1982.